Providing mothers who smoke with personalised results about the indoor air quality of their homes along with a motivational interview is feasible and has an effect on improving household air quality. Participants found the intervention understandable and acceptable. Taken overall, the results suggest that a future large-scale trial using measurements of indoor air quality as part of a complex intervention to reduce children's SHS exposure should be explored.

Objective: Treatment for childhood obesity is characterised by high attrition rates and failure to achieve weight maintenance. It is therefore important to develop more effective programmes. The aim of the present qualitative study was to explore the views of parents, children and health trainers to identify issues which can inform the development of more effective programmes. Design: A qualitative study combining in-depth interviews and focus groups. Participants were selected purposively from current and past attendees. Setting: WATCH-IT, a UK-based community child weight management programme. Subjects: Twenty-three families who had previously attended (or were currently attending) WATCH-IT were interviewed. Focus groups with ten trainers explored their views of the intervention. Results: Parents and children had different goals for involvement, with parents focusing on psychological benefits, while children concentrated on goals relating to weight loss and physical fitness. Parents were found to struggle to provide consistent support to their children and this was exacerbated by family dynamics. The child's commitment to lose weight, support from their family and a good relationship between the child and their trainer were viewed as important keys to successful weight management. Conclusions: The study will guide the design of existing and future programmes by providing insights into issues that challenge successful engagement. It highlights the possible value of exploring the therapeutic relationship between trainers and participants. Keywords Obesity management Children InterventionChildhood obesity is rising almost universally (1,2) . Given the significant long-term health consequences of childhood obesity it is important to consider how best to manage children who are already overweight or obese. The most recent Cochrane review of interventions for childhood obesity examined the results of sixty-four randomised controlled trials and concluded that programmes that involved the whole family and included aspects around nutrition, behaviour modification and physical activity were more effective than those targeting the obese child alone (3) . Although lifestyle interventions can reduce the level of obesity in children and adolescents, attrition rates for interventions were often high (3) . Evidence also suggests that, while children might lose weight following a lifestyle intervention, they often remain in the obese category (4) . It is therefore important to understand those factors associated with success on weight management programmes.Psychological theory can be used to understand how the beliefs of young people, family members and health trainers may influence young people's weight management behaviours. Bandura's Social Cognitive Theory (5) (SCT) proposes that behaviour is a function of aspects of the person and the environment, and that the primary drivers of behaviour change include skills (e.g. ability to exercise more or control calorie intake), self-efficacy (belief in one's ability to perf...

Preschool children's exposure to SHS in homes where the mother smokes is considerable. Interventions and policy development to increase parental awareness of the health effects of SHS and provide parents with the confidence to implement smoke-free households are required to reduce the SHS exposure of preschool age children.

This article explores mothers' narratives of changing home smoking behaviours after participating in an intervention (Reducing Families' Exposure to Smoking in the Home [REFRESH]) aimed at reducing families' exposure to secondhand smoke (SHS) in homes in Scotland. An analysis of qualitative findings illuminates quantitative changes in levels of SHS exposure. Prospective quantitative and qualitative data were drawn from 21 smoking mothers with at least one child under 6 years. Quantitative change was measured by home air quality, i.e. fine particulate matter <2.5μg (PM(2.5)). These measurements guided the organization of mothers into categories of change (smoke-free home at baseline [SFB], smoke-free home at final, some change and no change [NC]). Qualitative data from 17 mothers with non-SFB were analysed thematically within and across these categories. Three comparative case studies illustrate the varying changes made, barriers to change and how mothers valued such changes. The outcomes varied post-intervention, with homes smoke-free, partially smoke-free or making NC. The changes in home smoking behaviour were incremental, yet beneficial to reducing SHS exposure, and related to the nature of the restrictions and personal circumstances in the home pre-intervention. Across all change categories, mothers valued the changes they had made and expressed an intention to increase the changes.

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